Encephalitis in Trichinellosis: Solving the Dilemma

Dear Editor:

W e have noticed the letter entitled “Trichinellosis and Encephalitis” (Wiwanitkit, 2011) published in Foodborne Pathogens and Disease, which commented on our work “Reviews on Trichinellosis (II): Neurological Involvement” (Neghina et al., 2010). Its content is referring particularly to the closing remark of our review (“… trichinellosis must be considered in the differential diagnosis of any patient with encephalitis or other CNS malady of ambiguous etiology”) that confirms a previous classical observation made by Ryczak et al. (1987) (in a paper included in our bibliography).

Dr. Wiwanitkit stated without any pertinent explanation that “the described manifestations in this study might not be classified as actual encephalitis due to the pathogen.” Actually, as we have clearly shown in the chapter “Pathology and pathogenesis” (and particularly in Fig. 1), besides direct injury (due to the parasitic larvae) other indirect factors (e.g., eosinophils or immunologic reactions) are involved.

Further, according to his opinion, “encephalitis in trichinellosis is usually a complication detected in indexed cases and is actually a case of meningoencephalitis but not pure encephalitis.” Unexpectedly, as bibliographical support of his statement, Dr. Wiwanitkit lists only a single reference, and this related to a case report.

As we have noticed while preparing our review, the terms “encephalitis” and “meningo-encephalitis” were used interchangeably among different publications (and sometimes throughout the same work). Thus, to take just an example (due to space limitation), Gordon et al. (1935) noticed “the predominance of a picture of encephalitis throughout the entire course.” And there are many other reports (cited in our review—main text and supplementary material) in which the clinical signs and symptoms of encephalitis were well evidenced.

Finally, we highly appreciate that our work came into the attention of a world-leading expert in publishing rebuttals on scientific papers from almost all medical and biomedical fields.